Insurance Claims Resolution Specialist

2 weeks ago


Brentwood, Tennessee, United States MedCycle Management Full time
Job Description

Insurance Follow-Up Representative Overview: We are seeking qualified individuals to support insurance follow-up operations. In this position, you will collaborate with a healthcare organization's central business office to address outstanding insurance balances by reviewing payer balances, contracts, and Explanation of Benefits (EOBs) for suitable resolution.

Key Responsibilities:

  • Proactively engage in measures that lead to account resolution.
  • Respond promptly and accurately to all incoming communications and inquiries from insurance providers and other relevant parties.
  • Contact patients as necessary to facilitate account resolution.
  • Develop recommendations and action plans for resolving accounts effectively.
  • Handle all phone inquiries in a professional and courteous manner.
  • Document appropriate notes in the system for each account, detailing any actions taken.
  • Review EOBs to ensure that the necessary steps are executed in resolving accounts.
  • Conduct follow-up and system actions as required according to MedCycle guidelines.
  • Perform additional duties as assigned by management.

Qualifications:

  • Proficiency in Microsoft Office applications, including Outlook, Word, and Excel.
  • Attention to detail and the ability to research accounts to achieve appropriate resolutions.
  • Familiarity with medical terminology and a fundamental understanding of insurance processes.
  • Capability to solve practical problems and manage a variety of concrete variables in situations with limited information.

Preferred Experience:

  • High school diploma or equivalent; or one to three years of related experience and/or training; or a combination of education and experience.
  • A background in healthcare with experience in patient financial services is preferred.
  • Prior experience in insurance billing and/or follow-up is advantageous.


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